Periodontal disease is an inflammatory disease that begins as an inflammation of the gingival soft tissues (gums) and then proceeds to affect the supporting structures of the tooth in its bony socket. At present, periodontal disease is the most pressing dental malady that if untreated can result in tooth loss. Further, recent evidence suggests that this chronic dental infection, and its resulting widespread oral inflammation, can contribute to an increased risk for systemic complications including an increased risk for heart disease. With the discovery of fluoride and the resulting reduction in the prevalence of caries, periodontal disease and its earliest manifestation, gingivitis, has become the most prevalent and costly of dental infections. Gingivitis and its sequelae, periodontal disease, affects over 50% of the adult population.
Oral bacteria form a plaque biofilm that can initiate gingival inflammation. Under the appropriate circumstances, gingivitis can lead to periodontitis, which is manifested as an inflammatory-induced destruction of the bony support of the teeth. The disease is pandemic, costly, can result in tooth loss, and is also conjectured to increase the risk for coronary heart disease and other systemic conditions.
Currently, the existing technology used by a dentist or dental health professional to detect periodontal disease relies on a clinical examination that includes a periodontal probe and/or an x-ray. It is well known that these methods are imperfect because they are operator sensitive, time consuming and detect only past history of tissue destruction. Thus, there remains a need for improved ways of detecting periodontal disease.
Bone loss, the ultimate proof of disease, is measured by radiograph and is an end stage of disease, which for the most part is irreversible. The periodontal complex is best described as a peg in a socket: the tooth represented by the peg, and the alveolus, or surrounding bone, represented by the socket. The tooth is connected to its socket by collagen fibers that enable the tooth to respond to the forces of mastication and clenching and grinding. Inflammation causes bone loss that occurs by virtue of osteoclasts that eat away the bone and widen the socket, leading the affected tooth to become loose and ultimately non-functional. Bone loss of the periodontal tissues takes anywhere from 6-18 months to manifest itself.
Diagnosis of periodontal disease is initially based on measurements of soft tissue detachment from the tooth, which results in a periodontal pocket. Methods used to probe for attachment loss and to detect bone loss, the hallmark of the irreversible stage of periodontal disease, while quite specific are not very sensitive, and often delay diagnosis. A number of scientific advances have spawned technologies that are capable of detecting nanograms or picograms levels of inflammatory biomarkers in bodily fluids. These technologies could potentially be used to develop tests for early clinical diagnosis, which, if successful, could provide earlier warning of disease onset as compared to the relatively insensitive methods used currently.